Utilization Management Specialist - FT, Days

Prisma Health•Columbia, SC

1d•Onsite

About The Position

Provides clerical and data management support. Collects and summarizes routine operational and productivity data. Collects and enters data for assigned patient populations. Obtains authorizations for treatment and makes referrals where appropriate. Assists with administrative duties. All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.

Requirements

High school diploma or equivalent.
Two (2) years of clerical or administrative experience
Basic understanding of common medical and financial terminology preferred

Nice To Haves

Associate degree in Business or Healthcare related field of study preferred

Responsibilities

Runs daily, weekly, monthly and quarterly reports
Obtains and submits appropriate clinical documentation to the payors.
Responds to payor requests for additional documentation timely and accurately.
Updates and maintains authorization numbers and approved days in registration and/or case management systems
Obtains appropriate statistical data for patients in assigned patient population areas and communicates data to payors
Enters payor denial data into denial management or case management system
Answers, screens and prioritizes telephone calls, utilizing sound judgement regarding the urgency and content of the information
Processes faxes to and from payers for the Case Management team as assigned.
Secures discharge dates for payers.
Provides assistance with the discharge planning process including but not limited to sending information to receiving information from appropriate vendors/providers.
Ensures data entry is completed timely and accurately.
Ensures payor communication is completed timely and accurately.
Performs other duties as assigned.